Chapter One continues...

Apart from Wood, many others ‘discovers’ had their supporters. I would often hear physicians debate these claims – sometimes the physicians would be very patriotic… 

I overheard one physician saying he would never use a Pravaz syringe. He said he couldn’t get used to the screw plunger: “It is, after all, French!”

I’m sure such unconscious biases are still found today.  

A Pravaz syringe with “plated mounts, with screw piston rod, two fine gold needles, in morocco leather case.” From Surgical Instrument Catalogue, Arnold and Sons, London, 1885.

Given the many discovery claims for administering medicines beneath the skin, all within a relatively short time period, was there something in the background (‘in the air’ so to speak) that led to the discoveries?

Let me see what I can remember…

Syringes have been around a long time:

The use of a syringe to inject enemas has long been widely known.  In fact, it can be a common symbol for satire, especially in France.

The print here, Le Remède (1762), reflects Louis XIV of France’s ‘passion’ for the enema. Such prints seem to have amused countless people… I hear much play on the words of ‘prick’ and ‘needle.’ 

The nineteenth century saw new enema pumps marketed, some for self-administration, One, announced around the time of Wood’s syringe in the 1850s was Dr. Mattson’s “new” pump requiring one hand to use, and “adapted for all purposes of the male and female.”

Enema: La Remède (1762).
Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

We build upon the work before us:

The nineteenth century is noted for many new ways of preparing medicine, with the aim to improve accuracy and palatability. For example, following on from soft gelatin capsules (in the 1830s) came compressed tablets in the 1840s. This led to soluble hypodermic tablets developing around 1880. 

It may be of interest to you readers who live in Devon, that William Brockedon (who introduced these compressed tablets) was Totnes born. In many ways, his discovery led to dramatic developments in therapeutic practice.

At the same time, the innovations in commercial production contributed much to the growing pharmaceutical industry.

The illustration shows Brockedon’s equipment for hand preparation of compressed tablets and an advertisement (c. 1870s) for his preparations. 

W. Brockedon’s dies for tablet manufacture with advertisement.
Wellcome Collection. Attribution 4.0 International (CC BY 4.0)

Are there Eureka moments?

The first Eureka moment is attributed to Archimedes. It is said that on stepping out of a bath, he had that flash of inspiration leading to the Archimedes Principle

Lying here with no one wanting me, I’m always thinking about medical issues. I wonder if Alexander Wood — if we credit him as a discoverer — had a flash of inspiration, or was he just thinking over existing ideas when looking for the best way to inject under the skin?

Was he a discoverer or an innovator? What is the difference? Do we see an innovator as a person with curiosity, imagination, and a concern to improve on the status quo?  

The medical people I know often debate how discoveries are made. They remind me that medicine (and other “discovery”!) does not progress along straight paths…  It meets blind alleys and byways, some leading to failed treatments.
Archimedes stepping out of the bath saying "Eureka". Engraving, 1733. Wellcome Collection. Public Domain Mark

Sometimes I feel nothing is "out of the blue"!

I have to say that, when Alexander Wood became interested in subcutaneous injections during the 1840s, he followed many others, all with the same interest in introducing medicines directly into the body. The introduction of smallpox vaccination for example (which I will speak of later!) was one factor encouraging interest in injections, even if it scarred the skin.

Where do new ideas, new treatments, start? I hear them from many directions. Ranging, for instance, from some observations over time (perhaps from folklore or experiences in medical practice), to those commencing research and all that they find. These different pathways might even stir up disagreements and controversies that also foster new ideas. 

All this, from what I have witnessed (though that’s limited) means that flashes of inspiration come to those who have thought long and hard over a problem – those with the ‘prepared mind’! 

I leave you, dear readers, to ponder the matter further…

Survival of a fashionable device

In 1870 it was said that hypodermic injections of morphine had become a ‘fashion.’ I have to say, I have witnessed many physicians rushing to use a new treatment only for it to fade when expectations were not met. 

So why did we syringes survive? At first, our popularity depended much on the success of morphia (morphine) injections to control pain. Then manufacturers made syringes easier to use, and new injectable therapies came about. Some were so experimental – injecting “artificial serum” to treat ‘neurasthenia’ (nervous weakness or exhaustion), which was introduced by Jules Chéron. Our dear editor found a depiction of it in the hospital scene below.

Unhappily, new treatments were often uncomfortable for patients. I remember, rather than buying special large antitoxin syringes, one physician bewildered patients with multiple injections using a regular small syringe!

An injection at the Hôpital Saint-Lazare, Paris. Lithograph by E. Pirodon after J.R. Story. 1893.
Two glass ampoules of dysentery vaccine, Paris, France, 1917. Science Museum, London. Attribution 4.0 International (CC BY 4.0)

Though we are not without change!

There was a concern that the solutions used for injections were not sterile. A major contribution to sterilising came with the introduction of the glass ampoule. This is credited to a French pharmacist, Stanislas Limousin, in 1886. The ampoules can be sealed neck to top with a flame, and cracked open when they need to be used. 

However, his ampoules used solutions that were thought sterilised before he sealed them – they often turned out to be unsterile. This led to sterilising the contents after they had been placed in the ampoule.

Even so, this opened up further uncertainties! What heating conditions were required to ensure sterility but yet avoid a breakdown of the medication. And how to deal with the variety of bacteria and spores that needed to be killed?

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